Maternity care experience of Pakistani ethnic minority women in Hong Kong

Prevalence and determinants of anaemia in South Asian diaspora women residing in Hong Kong: An exploratory cross-sectional study

Background

Anaemia has been a significant public health challenge for the South Asian community, in particular women and migrant populations. Despite abundant research in developed Western settings, evidence in urbanized Asian settings is extremely scarce for comparisons. This study aims to assess the prevalence and social determinants of anaemia in South Asian women residing in Hong Kong, an advanced economy in Asia.

Methods

Between June 2022 and December 2023, 675 non-pregnant South Asian adult women were recruited through territory-wide outreach health assessments for anthropometric and biomedical measurements, in addition to a survey on self-reported sociodemographic, lifestyle, and health factors. Multivariable ordinal logistic regression was employed to identify the predictors of anaemia severity.

Results

The observed prevalence of mild and moderate/severe anaemia (haemoglobin level <12 g/dL) were 26.8 % and 31.4 %, respectively. Findings supported the independent protective role of better diet quality against anaemia severity (aOR=0.40 [95 % CI = 0.22, 0.73] for high diet quality compared to poor diet quality), and that women of reproductive age (aOR=2.36 [1.03, 5.44] for the 35-44 age group compared to the youngest group), having a larger household size (aOR=1.11 [1.01,1.21] per person increase), and staying for a longer period in Hong Kong (aOR=1.83 [1.07, 3.13] for > 7 years compared to < 3 years) were associated with more severe anaemia.

Conclusion

The high prevalence of anaemia in our sampled South Asian women in Hong Kong, especially those of reproductive age, was partly attributable to nutrition, acculturation, and cultural preference on larger family size, beyond potential genetic predisposition.

Young Adult Community Health Advisor-Led Intervention to Promote Colorectal Cancer Screening Uptake Among South Asians in Hong Kong: A Randomized Controlled Trial

BACKGROUND

Colorectal cancer is the most common cancer globally, and its prevalence is high in minority populations.

OBJECTIVES

To investigate the effectiveness of a young adult community health advisor (YACHA)-led intervention in enhancing the colorectal cancer (CRC) screening uptake rate among asymptomatic South Asians aged 50 to 75 years residing in Hong Kong and to investigate the acceptability of this intervention.

METHODS

A randomized controlled trial design was adopted. Eighty asymptomatic South Asian participants aged 50 to 75 years were recruited from the community in Hong Kong and then randomly allocated either to a YACHA-led intervention group or a control group. The intervention group received YACHA-led intervention, whereas the control group would receive the intervention after all follow-up assessments. The outcome measure was the uptake of CRC screening test. The acceptability of the intervention was explored through semistructured interviews.

RESULTS

The findings showed that the CRC screening uptake rate of the intervention group was significantly higher than that of the control group (85.0% vs 2.5%, P < .001). All the interviewees were satisfied with the intervention.

CONCLUSION

The YACHA-led intervention improves the uptake of CRC screening among asymptomatic South Asians.

IMPLICATIONS FOR PRACTICE

It is suggested that more resources should be allocated to empower young members of minority groups to reduce the health disparity.

Access of migrant women to sexual and reproductive health services: A systematic review

BACKGROUND

The number of people living in a different place from their place of birth is increasing year by year. Although women have always been involved in migratory movements, today they are increasingly doing so independently. Women are migrating from the Global South to higher-income countries. One of the challenges they face is access to sexual and reproductive health (SRH) services.

AIM

To identify the policy-level barriers that limit the access of migrant women to SRH services, their consequences, and strategies implemented to overcome these barriers.

METHODS

A systematic review of the literature was undertaken in accordance with the PRISMA statement. A search was undertaken for articles published between 2018 and 2023 focusing on migrant women's experiences of SRH services. In total, 462 articles were retrieved from PubMed (n = 135), Scopus (n = 94) and Web of Science (n = 233); of these, 28 articles were included in this review.

FINDINGS

The most common barrier to SRH services identified in the reviewed articles was lack of information (57 %), followed by language issues (43 %), cultural differences (39 %), economic status (25 %), administrative barriers (25 %) and discrimination (14 %). These barriers led to under-utilisation of maternity services and contraceptive methods. Strategies used by migrant women to overcome these barriers were primarily based on seeking help within their own community or family settings.

CONCLUSION

Strategies at institutional level to improve the access of migrant women to SRH services need to reduce existing barriers, promote health literacy, and train health workers to be culturally sensitive and responsive to the needs of migrant women.

South Asian women's views on and experiences of maternity care services in Hong Kong: A qualitative study

BACKGROUND

Health disparities among ethnic minority and migrant women can lead to adverse maternal and neonatal outcomes. This study explores the maternity care experiences of South Asian women in Hong Kong, providing insights for woman-centred and culturally responsive care in the East Asia.

OBJECTIVE

To understand South Asian women's views and experiences regarding maternity care services in Hong Kong.

METHODS

A qualitative descriptive study was conducted with 20 English-speaking South Asian women who had used maternity care services in Hong Kong within the past 5 years. Data were analysed by thematic analysis.

FINDINGS

Four themes were identified: 1) Comparing maternity care services in their home country versus Hong Kong; birth location, mode of birth and care. 2) Navigating Hong Kong maternal medical care system; including private public dual care and learning information from other South Asians. 3) The discrepancy in perception of optimum care; including a preferring for assistance with daily tasks, epidural anaesthesia, doctor-led care, and priority to infants' health. 4) The impact of the COVID-19 pandemic on maternity care experiences, including the cancellation of translation services and limited visiting hours.

DISCUSSION

South Asian appreciate Hong Kong's public maternity services due to its perceived greater cost-effectiveness. The major incongruence between expectations and services provided being women-staff communication.

CONCLUSION

The quality of healthcare in Hong Kong is appreciated. Individualized care should be offered to cater to diverse needs. Improvements in staff attitude and provision of detailed information should help alleviate feelings of differential treatment.

Beyond individual responsibility towards healthy food choices: A qualitative study among Pakistani women in Hong Kong

While biomedical understandings of food and diet coupled with discourses on individual responsibility towards healthy food choices are nowadays prominent, other social and cultural meanings attached to food and diet are largely devalued. The limits of such a reductionist approach are more evident when related to the experiences of migrant and ethnic populations, whose alternative knowledge(s) and practices about food and health are especially neglected. A multicultural city with a public healthcare system inherited from the British colonial times and largely shaped by biomedical ideas of health, Hong Kong offers a lens into the limits of such a reductionist approach. Due to their vulnerability in the context of Hong Kong as shaped by intersecting social identities, 72 women from Pakistan were recruited to be our community partners in a community-based participatory action research project to investigate their health needs and concerns. 12 focus group discussions were conducted, exploring their experiences of "healthy" food and overweight especially related to their encounters with the Hong Kong public healthcare system, as these issues emerged as key health concerns within the community. Four major themes emerged: unmet expectations of care, health is beyond the individual, constraints to a healthy diet in the context of migration, and beyond health: food as care for diasporic women. This study highlights the limit of a reductionist approach to healthy food as merely based on nutrition and individual responsibility. It stresses the need of a counter-discourse in the field of public health, emphasizing not only alternative cultural ideas of health and food, but also enlarging the field of health in biomedical terms to embrace "care" and acknowledging the structural constraints shaping migrant and ethnic population's vulnerability in making "healthy" food choices.